Digital Case

Department of Neurology

The Department of Neurology is integrated into the Neurological Institute at University Hospitals Case Medical center. The Case Department of Neurology is based at five sites in Cleveland: University Hospitals - Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Richmond Medical Center, Bedford Medical Center and Case Western Reserve School of Medicine. Clinical consultations and laboratory services are also available in the surrounding community at the University Suburban Health Center in South Euclid, the Chagrin Highlands Health Center in Orange, the Westlake Health Center in Westlake, Ohio, and the University Foley Elder Health Center on Fairhill Road in Cleveland. Clinical areas of expertise include cerebrovascular disroders, critical care neurology, epilepsy, neuromuscular disorders, multiple sclerosis, movement disorders, autonomic disorders, myasthenia gravis, neuro-oncology, sleep, neuro-ophthalmology, and memory and aging disorders. Laboratory services include electroencephalopathy (EEG), video-EEG monitoring, nerve conduction studies and electromyography (EMG), single-fiber EMG, and autonomic testing. There are large neurology residency training program and offer several subspecialty fellowships.

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The Department of Neurology is integrated into the Neurological Institute at University Hospitals Case Medical center. The Case Department of Neurology is based at five sites in Cleveland: University Hospitals - Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Richmond Medical Center, Bedford Medical Center and Case Western Reserve School of Medicine. Clinical consultations and laboratory services are also available in the surrounding community at the University Suburban Health Center in South Euclid, the Chagrin Highlands Health Center in Orange, the Westlake Health Center in Westlake, Ohio, and the University Foley Elder Health Center on Fairhill Road in Cleveland. Clinical areas of expertise include cerebrovascular disroders, critical care neurology, epilepsy, neuromuscular disorders, multiple sclerosis, movement disorders, autonomic disorders, myasthenia gravis, neuro-oncology, sleep, neuro-ophthalmology, and memory and aging disorders. Laboratory services include electroencephalopathy (EEG), video-EEG monitoring, nerve conduction studies and electromyography (EMG), single-fiber EMG, and autonomic testing. There are large neurology residency training program and offer several subspecialty fellowships.

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This review examines the large body of toxicological and epidemiological information on human exposures to chlorpyrifos, with an emphasis on the controversial potential for chlorpyrifos to induce neurodevelopmental effects at low doses. The results of this review dem...

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This review examines the large body of toxicological and epidemiological information on human exposures to chlorpyrifos, with an emphasis on the controversial potential for chlorpyrifos to induce neurodevelopmental effects at low doses. The results of this review demonstrate that the use of urinary 3,5,6-trichlorpyridinol (TCPy), a metabolite of chlorpyrifos as a biomarker of nonoccupational exposure is problematic and may overestimate nonoccupational exposures to chlorpyrifos by 10-to 20-fold because of the widespread presence of both TCPy and chlorpyrifos-methyl in the food supply. Current “background” (nonoccupational) levels of exposure to chlorpyrifos are several orders of magnitude lower than those required to inhibit plasma cholinesterase activity, which is a more sensitive target than nervous system cholinesterase. However, several in vitro studies have identified putative neurodevelopmental mechanisms that are altered at concentrations of chlorpyrifos below those that inhibit cholinesterases. Although one human cohort study reported an association between maternal and cord blood chlorpyrifos levels and several measures of neurodevelopment, two other cohort studies that utilized urinary TCPy as a surrogate for chlorpyrifos exposure did not demonstrate an association. Although the weight of the scientific evidence demonstrates that current levels of chlorpyrifos exposure will not have any adverse effects on neurodevelopment that might result from inhibition of nervous system cholinesterases, several recent studies propose alternative mechanisms. Thus, further in vivo investigation on neurodevelopment in an appropriate animal model is needed; additional epidemiological studies may be warranted if a suitable, chlorpyrifos-exposed cohort can be identified and more rigorous measures of exposure are utilized.